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Prostate Cancer

Glossary of Terms

3DCRT (3-Dimensional Conformal Radiation Therapy):

An approach to radiation treatment planning that focuses on directing the radiation energy to the tumor target while sparing surrounding normal tissues.

5-ALPHA REDUCTASE (5-AR):

The enzyme that converts testosterone to dihydrotestosterone (DHT).

ADENOCARCINOMA:

A form of cancer that develops from a malignant abnormality in the cells comprising a glandular organ, such as the prostate. Almost all prostate cancers are adenocarcinomas.

ADVANCED PROSTATE CANCER:

Prostate cancer that is no longer organ-confined; systemic prostate cancer, sometimes with metastases to lymph nodes, seminal vesicles, bone, or vital organs of the body such as liver and/or lungs. Advanced prostate cancer is treated with systemic therapies currently in use such as androgen deprivation and chemotherapy.

AGONIST:

A chemical substance, such as a drug, capable of combining with a receptor on a cell and initiating a reaction or activity. In PC, the LHRH agonist is also called LHRH-A. The most commonly used LHRH-As are Lupron and Zoladex. Either of these agents interacts with the LHRH receptor and forms a complex that results in a decrease in the release of LH over a period of 2 weeks and hence a lowering in serum testosterone.

ALGORITHM:

In prostate cancer, one of a group of systems whereby the human experiences of a number of patients are statistically or numerically analyzed to produce data that can be generalized to predict the probable disease status of patients who have not yet been treated and therefore have no empirical data of their own on which to base judgments regarding their disease status. Examples include the Partin Tables, Narayan Stage, and Kattan Nomograms.

ALPHA-1 BLOCKERS:

Oral medications prescribed to improve urine flow by relaxing periurethral smooth muscle tissue; those of the quinazoline class (Hytrin and Cardura) have been shown to be synergistic with Proscar in causing programmed cell death in prostate cells, both benign and malignant.

ALPHA-TOCOPHEROL ISOMER:

A component of vitamin E.

AMERICAN UROLOGICAL ASSOCIATION (AUA) SYMPTOM INDEX SCORE:

A series of subjective questions used by physicians to evaluate the extent of existing lower urinary tract symptoms.

ANASTOMOSIS:

In prostate cancer, the surgical connection made between the bladder neck and the remaining urethra after the prostate is removed.

ANASTOMOTIC STRICTURE:

In prostate cancer, a narrowing at the site of the anastomosis between the bladder neck and urethra after radical prostatectomy.

ANDROGEN:

A hormone produced primarily by the testicles, but also in the cortex of the adrenal glands, that is responsible for male characteristics and the development and function of the male sexual organs and also affects muscle and bone mass, emotional stability, cognitive function, skin and hair, and so forth.

ANDROGEN-DEPENDENT PC (ADPC):

Prostate cancer cells that depend on androgens for continued growth and vitality.

ANDROGEN DEPRIVATION SYNDROME (ADS):

A constellation of symptoms directly or indirectly due to the drop in testosterone that occurs following surgical castration or the suppression of testicular and adrenal androgens by the use of medications.

ANDROGEN DEPRIVATION THERAPY (ADT):

A prostate cancer treatment that is based on blocking the amount of available androgen to the prostate cancer cell.

ANDROGEN-INDEPENDENT PC (AIPC):

Prostate cancer cells that do not depend on androgen for growth.

ANDROGEN RECEPTOR:

A structural entity that is essentially a docking site for androgen to communicate with the cell and affect cell function. The substance interacting with the receptor is called a ligand. The interaction of ligand and receptor is a major mode of biochemical communication in all life forms.

ANEUPLOID:

Cells that have an abnormal number of sets of chromosomes. Aneuploid cancer cells tend not to respond as well to androgen deprivation therapy.

ANGIOGENESIS:

Relating to the formation of blood vessels.

ANTAGONIST:

A chemical that acts within the body to reduce the physiological activity of another chemical substance.

ANTIGEN:

A substance that elicits a cellular-level immune response or causes the formation of an antibody.

APOPTOSIS:

Programmed cell death due to an alteration in a critical substance or chemical necessary for cell viability. For example, the lack of male hormones causes apoptosis of androgen-dependent prostate cancer cells.

ARACHIDONIC ACID (AA):

An omega-6 fatty acid that is known to generate free radicals and is considered an unfavorable eicosanoid. AA is metabolized via enzymes of the COX and LOX family to generate prostaglandins, thromboxanes, leukotrienes, hydroxylated fatty acids, lipoxins, and 5-HETE compounds that are implicated in cancer, inflammatory disease, immune dysfunction, and degenerative disorders. Organ meats and egg yolk are rich in AA.

ARTIFICIAL NEURAL NET (ANN):

An approach to analyzing data that uses statistical analysis of historical data to produce systems that can predict probabilities of future outcomes based on inputted variables.

BASELINE PSA:

The PSA level before a new treatment has begun; used to establish the efficacy of a therapy based on response of the PSA to treatment.

BENIGN:

Not malignant; noncancerous.

BENIGN PROSTATE HYPERPLASIA OR HYPERTROPHY (BPH):

A noncancerous condition of the prostate that results in the growth of both glandular and stromal (supporting connective) tissue, enlarging the prostate and potentially leading to obstructive symptoms relating to urine flow (see American Urological Association Symptom Index Score).

BILATERAL:

Both sides; for example, a bilateral nerve-sparing radical prostatectomy is one in which the nerves on both sides of the prostate are left intact.

BIOMARKER:

An indicator of biological activity of cells or tissues that can be used as a means to monitor a state of health or disease. PSA is one of the most useful biomarkers in medicine.

BIOPSY:

Sampling of tissue from a specific part of the body in order to check for abnormalities such as cancer.

BISPHOSPHONATES:

A class of compounds that stops bone loss (resorption) by actions directed against the osteoclast.

BONE SCAN:

An imaging technique using a radioactive isotope that is selectively taken up by bone tissue to identify abnormal or cancerous growths within bone such as metastases.

BRACHYTHERAPY:

A form of radiation therapy in which radioactive seeds or wires are used to deliver the radiation dose close to the site of a tumor. Seeds can be permanently implanted or radioactive wires can be temporarily introduced and then withdrawn after the radiation dose is delivered.

CANCER:

The growth of abnormal cells in the body in an uncontrolled and disordered manner, invading surrounding tissues and sometimes spreading to distant sites within the body via the bloodstream and/or lymphatic system.

CARCINOEMBRYONIC ANTIGEN (CEA):

A biomarker of prostate cancer that may be expressed in prostate cancer variants associated with higher Gleason scores, for example, Gleason scores 8-10 may indicate that androgen-independent cells are present.

CASODEX:

Brand name of an antiandrogen medication that functions by occupying and therefore blocking the androgen receptor, thus preventing natural androgens from stimulating cell growth.

CAT or CT SCAN (COMPUTERIZED AXIAL TOMOGRAPHY):

An imaging method used to identify abnormalities by combining images from multiple X-rays under the control of a computer to produce cross-sectional or three-dimensional pictures of internal structures.

CBC (COMPLETE BLOOD COUNT):

Complete blood workup including white blood count, hematocrit, and platelet count.

cc (CUBIC CENTIMETERS):

Used as a measurement of prostate gland volume or amount of prostate cancer; cubic centimeters are equivalent to grams (g) in determinations of prostate gland volume.

cGy (centiGray):

A unit of measurement of radiation dose; 1 cGy equals the energy absorbed from ionizing radiation equal to 1 joule (a unit of energy) per kilogram.

CHEMOTHERAPY:

The use of pharmaceuticals or other chemicals to kill cancer cells. In many cases these agents may also damage normal cells in the process of killing cancer cells, resulting in various adverse side effects.

CHROMOGRANIN A (CGA):

A biomarker of prostate cancer that may be expressed in prostate cancer variants associated with higher Gleason scores, that is, Gleason scores 8-10. Progressive increases of CGA in the blood indicate an aggressive clone of prostate cancer is present that exhibits an increased tendency to metastasize to lymph nodes, liver, and lungs. CGA is produced by the neuroendocrine cells associated with androgen independent PC.

CLINICAL STAGE:

The TNM (tumor, nodes, metastases) system of classification for communicating extent of disease in a specific patient based on all available information. This system has largely replaced the older Whitmore-Jewett staging classification system.

CORE INVOLVEMENT:

Expressed as a percentage; indicates the amount of biopsy cores involved by prostate cancer divided by the total number of cores that have been sampled. If 12 cores of tissue were obtained and 6 showed PC, then the percentage core involvement would be 50%.

COX-2 (CYCLOOXYGENASE 2):

The enzyme that converts arachidonic acid to prostaglandin E2. Inhibition of COX-2 is now an important approach to reducing the production of unfavorable eicosanoids implicated in the cause and progression of malignancy and inflammatory disorders.

CRYOPROBES:

The hollow probes used to freeze tissue during a cryosurgery procedure.

CRYOSURGERY:

The use of liquid nitrogen or argon gas circulated through cryoprobes to freeze and kill tissue, including any cancerous tissue.

DEDIFFERENTIATION:

Relatively more primitive in appearance and function than well-differentiated cells that, by contrast, are mature and able to function properly. As the disease progresses, cancer cells become more dedifferentiated (i.e., primitive) than normal cells, losing the characteristics that normal cells possess.

DEXA SCAN:

An imaging procedure used to evaluate bone mineral density and evaluate the status of bone integrity as regards a diagnosis of osteopenia or osteoporosis. The DEXA may understate the true extent of abnormality by attributing unrelated conditions such as arthritis and vascular calcifications to normal bone density.

DIAGNOSIS:

The evaluation of signs, symptoms, and tests to determine physical and biological causes of these signs and symptoms and evaluate whether a specific disease or disorder is involved.

DIGITAL RECTAL EXAMINATION (DRE):

The use by a physician of a lubricated and gloved finger inserted into the rectum to feel for abnormalities of the prostate and rectum.

DIHYDROTESTOSTERONE (DHT):

A male hormone five times more potent than testosterone; DHT is converted from testosterone within the prostate and in other tissues by the enzyme 5-alpha-reductase.

DIPLOID:

Cells having one complete set of 46 normally paired chromosomes, that is, a normal amount of DNA. Diploid cancer cells grow relatively slowly and usually respond well to androgen deprivation therapy.

DNA (DEOXYRIBONUCLEIC ACID):

The basic biologically active chemical that defines the physical development and growth of nearly all living organisms; a complex protein that is the carrier of genetic information.

DOWNREGULATING (DOWNREGULATION):

Turning off a mechanism of action in the body at the biochemical level.

DUTASTERIDE (AVODART):

A 5-alpha-reductase inhibitor that prevents the conversion of testosterone to the five times more potent dihydrotestosterone (DHT). Unlike Proscar, which blocks only 5-alpha reductase Type II, dutasteride also blocks 5-alpha reductase Type I.

EICOSANOIDS:

Hormones made within the cell membrane of every living cell in the body controlling every physiological function. Eicosanoids have opposing actions operating as a check-and-balance system. Therefore, a balance of these opposing actions is essential for optimal health.

EICOSAPENTENOIC ACID (EPA):

An omega-3 fatty acid that has been shown to inhibit the formation of AA by inhibiting the enzyme delta-5 desaturase, which converts DGLA to AA.

EJACULATION:

The release of semen through the penis during orgasm.

ENDOCRINE GLAND:

Any of various glands producing hormonal secretions that pass directly into the bloodstream. Examples of endocrine glands include the thyroid, parathyroids, anterior and posterior pituitary, pancreas, adrenals, pineal, and gonads.

ENDORECTAL MRI:

Magnetic resonance imaging of the prostate using a probe inserted into the rectum.

ENZYME:

Any of a group of chemical substances that are produced by living cells and cause particular chemical reactions to happen while not being changed themselves.

EPITHELIAL CELL:

A cell type in the prostate gland that lines the ducts and functionally secretes substances such as PSA into the bloodstream or into the duct openings or lumens.

EULEXIN:

The brand name of an antiandrogen that blocks the androgen receptor and prevents testosterone and/or DHT from stimulating cell growth.

EXTERNAL BEAM RADIATION THERAPY (EBRT):

A form of radiation therapy in which the radiation is delivered by a machine directed at the area to be radiated as opposed to radiation given within the target tissue, such as brachytherapy.

EXTRACAPSULAR EXTENSION:

A disease status in prostate cancer in which the cancer has penetrated the outer shell or capsule of the prostate and extends into the periprostatic tissue.

FINASTERIDE (PROSCAR):

An inhibitor of the 5-alpha-reductase Type II enzyme, which converts testosterone to the five times more potent dihydrotestosterone (DHT); used to treat BPH and PC.

FOLLICLE STIMULATING HORMONE (FSH):

A hormone produced in the pituitary gland that, in males, stimulates cells (Sertoli cells) in the testicles to make sperm; may be a factor in prostate cancer growth because FSH receptors have been identified on prostate cancer cells.

FREE PSA:

PSA unbound to any major protein; free PSA relates to benign prostate growth. The percentage of free PSA is one indicator of whether or not prostate cancer is likely present.

FREE RADICALS:

Substances that damage cell membranes and disrupt the integrity of the cell; reactive oxygen species (ROS).

GAMMA-LINOLENIC ACID (GLA):

One of the building blocks of eicosanoids that is metabolized to DGLA. The pathway that is taken after metabolism to DGLA is either toward AA and the unfavorable eicosanoids or toward the production of good eicosanoids such as PGA1 and PGA2.

GAMMA-TOCOPHEROL ISOMER:

A component of vitamin E.

GLAND:

A structure or organ that produces a substance that may be used in another part of the body.

GLAND VOLUME:

The volume of the prostate gland in cubic centimeters or grams. (Both units of measurement, cubic centimeters and grams, yield the same result.)

GLEASON GRADE:

After Donald Gleason, M.D. who developed the Gleason grading system as a tool to profile the aggressiveness of prostate cancer. A number from 1 to 5 that describes one of the two most predominant tissue patterns seen in the microscopic analysis of glandular architecture. The primary grade is the most predominant pattern, comprising 51% to 95% of the specimen, while the secondary grade comprises 5-49%.

GLEASON SCORE (GS):

The two Gleason grades, represented as (primary grade, secondary grade). An example of a high Gleason score would be (4,4) or (5,4) compared to a Gleason score of (3,3), the most common Gleason score at the time of diagnosis of PC.

GLYCEMIC INDEX (GI):

A measurement of the rate of carbohydrate entry into the bloodstream.

GLYCEMIC LOAD (GL):

The amount of insulin-stimulating carbohydrate multiplied by the glycemic index of the carbohydrate.

HDR:

See High-Dose Rate Brachytherapy

HEREDITARY:

Traits inherited from one's parents and from earlier generations via their DNA.

HIGH-DOSE RATE (HDR) BRACHYTHERAPY:

Involves inserting iridium wires into the prostate gland through hollow plastic needles that are placed under transrectal ultrasound guidance. Once the radiation dose is delivered, the wires are withdrawn from the prostate.

HORMONE:

Substances that are produced in the body that act as messengers, communicating information between cells. Usually peptides or steroids, they are produced by one tissue and delivered via the bloodstream to another tissue to affect physiological activity such as growth or metabolism.

HYPERINSULINEMIA:

A state of high insulin levels in the blood that can be caused by disproportionate consumption of simple or complex carbohydrates in the diet in proportion to dietary proteins and fats.

HYPOXIC CENTER:

The center of a prostate cancer tumor in which a state of lower oxygen tension exists. This stimulates VEGF, a substance that stimulates the blood vessel growth necessary for the nourishment of the tumor.

IMAGING:

A radiology technique or method allowing a physician to see something that would not ordinarily be visible. Imaging studies include X-ray examinations, CT scans, bone or other nuclear medicine scans, and MRI and ProstaScint studies.

INTENSITY MODULATED RADIATION THERAPY (IMRT):

An approach to external beam radiation therapy delivery using sophisticated computer planning to specify the tumor target dose and the amount of radiation allowable to nearby tissues and to modulate the intensity of the radiation as the delivery system rotates around the patient, thus minimizing damage to normal tissues.

INTERFERON:

A molecule that is active against viruses and cancer cells.

INTERLEUKIN-6 (IL-6):

A cell product made by the primary tumor as well as by osteoblasts that facilitates bone resorption and promotes osteopenia and osteoporosis by stimulating mature osteoclasts to break down bone.

INTERFERON-SIGNALING PATHWAY (ISP):

One of the defensive pathways that healthy cells use against the development of malignancy and invasion by viruses involving the interaction of interferon, which is produced in response to an invader.

KATTAN NOMOGRAMS:

Various algorithms named after Michael Kattan that present probabilities of response to therapies, such as radical prostatectomy, external beam RT, and seed implantation based on a combination of biological inputs such as PSA, Gleason score, and clinical stage.

KELOID:

Excessive scar tissue at the site of a surgery or an internal procedure. A history of this type of scar tissue formation may indicate the probability of the development of anastomotic stricture after radical prostatectomy.

LACTIC DEHYDROGENASE (LDH):

Elevated levels of this substance are associated with high Gleason score prostate cancer. LDH used to be routinely included in the standard chemistry panel and was considered an excellent overall tumor marker. For reasons unclear, LDH has been omitted from the standard panel.

LHRH ANTAGONIST:

An agent that blocks the LHRH receptor by pure antagonism without the initial release of LH, which is responsible for causing a testosterone surge seen with LHRH agonists; Abarelix (Plenaxis) is an example of an LHRH antagonist.

LIGAND:

A protein or an enzyme that combines with its appropriate binding site or receptor. The interaction of a ligand and its receptor initiates a biochemical reaction leading to the synthesis of other substances, often proteins, hormones, or enzymes. Almost all reactions in the human body involve ligands interacting with their appropriate receptors.

LNCaP:

One of the many prostate cancer cell lines. LNCaP is an androgen-dependent cell line.

LOWER URINARY TRACT SYMPTOMS (LUTS):

Urinary difficulties including slow stream, urinary urgency, difficulty in starting urination, and incomplete emptying of the bladder. These symptoms are quantified in the AUA Symptom Index or Score.

LUPRON:

Brand name of one of the drugs acting as an LHRH agonist.

LUTEINIZING HORMONE (LH):

A pituitary hormone that stimulates the Leydig cells within the testicles to produce testosterone.

LUTEINIZING HORMONE-RELEASING HORMONE (LHRH):

Hormone from the hypothalamus that interacts with the LHRH receptor in the pituitary to release LH which in turn stimulates Leydig cells in the testicles to make testosterone.

LYMPH NODES:

Small glands occurring throughout the body that filter out bacteria and other toxins, including cancer cells. During the process of metastasis, they are one of the first sites of involvement when the cancer leaves the primary site of origin.

MAGNETIC RESONANCE:

Absorption of specific frequencies of radio and microwave radiation by atoms placed in a strong magnetic field.

MAGNETIC RESONANCE IMAGING (MRI):

Use of magnetic resonance with atoms in the body tissues to produce distinct cross-sectional or three-dimensional images of internal structures.

MALIGNANCY:

A growth or tumor composed of cancerous cells.

MALIGNANT:

Cancerous; tending to become progressively worse and to result in death; having the invasive and metastatic (spreading) properties of cancer.

METASTASIS (pl. METASTASES):

Secondary tumor formed as a result of a cancer cell or cells from the primary tumor site traveling to a new site and growing there.

MICROVESSEL DENSITY:

An objectified measurement of angiogenesis.

mL (MILLILITER):

Unit of volume equal to one-thousandth of a liter.

NARAYAN STAGE:

Part of the algorithm developed by Perry Narayan that assesses if the microscopic findings of prostate cancer were limited to one side of the prostate (Narayan B1) or both sides (Narayan B2).

NERVE-SPARING:

A technique used in radical prostatectomy in which the erectile nerves are left intact by the surgeon.

NEURON-SPECIFIC ENOLASE (NSE):

A biomarker of prostate cancer that may be expressed in prostate cancer variants associated with higher Gleason scores, that is, Gleason scores 8-10.

ng (NANOGRAM):

Unit of measurement that is one-billionth of a gram.

NOMOGRAM:

A graphic representation, often used in analyzing data, consisting of several lines marked off to scale. Specific variables such as PSA, Gleason score, clinical stage, etc. are given point values. The sum of all the points equates with the prognostic outcome.

OBJECTIFIED ONGOING OBSERVATION:

A more appropriate term than watchful waiting that indicates that a patient not undergoing a definitive procedure using surgery or radiation or other treatments will be objectively monitoring his biological status in a consistent ongoing fashion.

ONCOGENES:

Genes relating to tumor growth.

ONCOLOGY:

The branch of medical science dealing with tumors. Oncologists study cancer and treat patients who are afflicted with cancer.

ONCOLYTIC VIRUS:

A virus that can kill tumor cells having defects in the interferon-signaling pathway or by other mechanisms.

ORGAN:

A group of tissues that work in concert to carry out a specific set of functions in the body.

ORGAN-CONFINED DISEASE:

Prostate cancer that is apparently confined to the prostate as determined either by clinical findings or, in the case of radical prostatectomy, by pathological findings; prostate cancer that has not penetrated the prostate capsule.

OSTEOBLAST:

A cell type within bone that promotes bone formation.

OSTEOCLAST:

A cell type within bone that promotes breakdown of bone or bone resorption.

OSTEOPENIA:

A condition of bone that indicates that an imbalance between bone formation and resorption is compromising bone integrity. Osteopenia indicates that the degree of bone loss is more than 1 standard deviation from the WHO definition of normal, but not more than 2.5 standard deviation below that level.

OSTEOPOROSIS:

A reduction in bone mineral density that is more that 2.5 standard deviation below the normal level defined by the WHO.

PARTIN TABLES:

Tables constructed based on results of the PSA, clinical stage, and Gleason score and associating those values with the findings at radical prostatectomy. Data involving thousands of men with PC used to predict the probability that the prostate cancer has penetrated the capsule, spread to the seminal vesicles or lymph nodes, or has remained confined to the prostate. The tables were developed by a group of scientists at the Brady Institute for Urology at Johns Hopkins Medical Center.

PATHOLOGICAL STAGE:

The extent of disease as determined by a pathologist's microscopic analysis of tissue removed at the time of surgery.

PERIPROSTATIC:

Pertaining to the soft tissues immediately adjacent to the prostate gland.

PLOIDY:

DNA analysis to establish whether normal or abnormal numbers of pairs of chromosomes are present in a cell.

PROCTITIS:

Inflammation of the rectum; may be an adverse effect of radiation therapy used to treat prostate cancer.

PROSCAR:

Brand name of finasteride, a 5-alpha-reductase inhibitor that blocks the conversion of testosterone to DHT.

PROSTAGLANDIN:

An eicosanoid isolated from the prostate gland that acts locally, metabolizes rapidly, and has a hormone-like effect, stimulating target cells into action.

PROSTAGLANDIN E2 (PGE2):

A major metabolite of arachidonic acid, known to stimulate vascular endothelial growth factor (VEGF) and hence, angiogenesis.

PROSTASCINT:

A monoclonal antibody (mAb) tagged with a radioactive isotope that is used to detect prostate cancer, particularly within lymph nodes. The ProstaScint mAb is directed against the prostate-specific membrane antigen (PSMA). PSMA is associated with androgen-independent PC. A few centers are using the ProstaScint scan to identify PC in the prostate gland.

PROSTATE:

The gland surrounding the urethra and immediately below the bladder in males.

PROSTATE CANCER:

Adenocarcinoma of the prostate gland.

PROSTATECTOMY:

Surgical removal of part or all of the prostate gland. If the entire gland is removed, a radical prostatectomy has been performed. Transurethal resection of the prostate (TURP), performed to improve urinary difficulties, is an example of removal of part of the gland.

PROSTATE-SPECIFIC ANTIGEN (PSA):

A protein secreted by the normal epithelial cells of the prostate gland as well as by prostate cancer cells if they are present. Elevated PSA levels in the blood can be due to benign or malignant causes. After diagnosis of prostate cancer, this biomarker is typically used to monitor disease progression and/or response to therapy.

PROSTATIC ACID PHOSPHATASE (PAP):

An enzyme or biomarker secreted by prostate cells that is associated with a higher probability of disease outside the prostate when pretreatment levels are 3.0 or higher. PAP elevations connote that the disease is not organ-confined disease.

PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN):

A pathologically identifiable condition believed to be a possible precursor of prostate cancer; broken down into high-grade PIN or PIN 2 and PIN 3 versus low grade PIN or PIN 1. High grade PIN is associated with having PC.

PROSTATITIS:

Infection or inflammation of the prostate gland that can be treated with medication and/or prostate massage.

PSA ASSAY:

The means by which a blood sample is analyzed to determine its PSA content. Various assays can result in different in readings from the same sample; therefore, it is wise to use the same assay for each subsequent PSA test. Very sensitive assays that measure PSA down to two or three decimal points are called hypersensitive or ultrasensitive PSA assays. These assays play a major role in early detection of relapse after radical prostatectomy or in the assessment of the tumor cell population in response to ADT.

PSA DENSITY (PSAD):

The amount of PSA (expressed in nanograms) for each cubic centimeter of prostate volume; the serum PSA value divided by an accurate gland volume determination.

PSA DOUBLING TIME:

The length of time in months that it takes for the PSA to double in amount.

PSA LEAK:

The secretion of PSA from the cells into the blood. Low levels of serum PSA are often associated with higher Gleason scores, as an expression of less PSA leak because more aggressive prostate cancers lose the ability to secrete PSA. Thus, PSA is an unreliable marker of disease progression in high Gleason score prostate cancer, e.g., Gleason scores 8-10.

PSA RECURRENCE (PSAR):

Elevated PSA following treatment of prostate cancer, signaling that cancer cells are still present and that monitoring for disease progression is indicated.

PSA RELAPSE-FREE SURVIVAL:

Survival of the patient that relates to no evidence of a progressively rising PSA.

PSA TREND:

The slope that a series of PSA readings over time would exhibit on a graph.

PSA VELOCITY:

A statement of how fast the PSA is accelerating; the rate of change in PSA calculated per year of time.

PYRILINKS-D (Dpd):

Deoxypyridinoline, or Dpd, is a laboratory test to monitor the biologic endpoint of bone resorption activity obtained by analysis of the second-voided urine of the day.

QCT SCAN:

Quantitative CT bone densitometry; a superior way to evaluate bone density compared to the DEXA scan because it is uninfluenced by unrelated conditions such as arthritic changes and/or vascular calcifications. (Telephone numbers that may be helpful in finding QCT sites near you: Mindways, (877) 646-3929 ( www.qct.com ), or Image Analysis, (800) 548-4849 ( www.image-analysis.com ).)

RADIATION THERAPY (RT):

The use of X-rays and other forms of radiation to destroy malignant cells and tissue.

RADICAL PROSTATECTOMY (RP):

Surgical removal of the entire prostate gland and seminal vesicles.

RECEPTOR:

A docking site on the cell membrane in the cell cytoplasm or in the nucleus that interacts with a ligand. All cells have multiple receptors.

RECURRENCE:

The reappearance of disease manifested by clinically based findings, either upon physical examination or by the results of laboratory findings such as a rising PSA.

RESORPTION:

Loss of bone caused by an imbalance in the dynamics of bone formation by osteoblasts or bone loss due to breakdown of the bone by osteoclasts.

RISK ASSESSMENT:

An analysis of probabilities related to a specific patient's case, obtained by analyzing medical variables of known significance and used to derive an overall impression of how different disease management options would impact an optimal or suboptimal outcome for the patient.

SCREENING:

Evaluation of populations of people who have no symptoms of the disease for which they are being evaluated in an effort to diagnose disease in its early stages.

SEED IMPLANTATION (SI):

A treatment for prostate cancer in which radioactive seeds encased in titanium shells are permanently implanted into the prostate gland.

SELENOMETHIONINE:

A substance that shows an inhibitory effect on certain prostate cancer cell lines that appear to be independent of androgen receptor or PSA pathways.

SEMINAL VESICLES:

Glandular structures located above and behind the prostate that secrete and store seminal fluid. Seminal fluid is one component of ejaculate.

STAGE:

See CLINICAL STAGE, PATHOLOGICAL STAGE.

SYSTEMIC:

Throughout the whole body; in prostate cancer, cancer that is no longer organ-confined.

TESTOSTERONE (T):

The male hormone or androgen that comprises most of the androgens in a man's body. Chiefly produced by the testicles, testosterone is essential to virtually every male function from the brain to toenails.

THERAPEUTIC INDEX (TI):

Treatment benefit divided by treatment side effects.

THERMOCOUPLES:

In relation to prostate cancer, devices used during cryosurgery to monitor the temperature achieved by cryoprobes, thus helping to improve the therapeutic index of the procedure.

TRANSFORMING GROWTH FACTOR BETA-1 (TGF-b1):

A growth factor produced by prostate cells, as well as by cells of the bone matrix. Elevated plasma levels of TGF-b1 obtained at baseline are associated with distant disease involving bone and/or lymph nodes.

TRANSRECTAL:

Through the rectum (as in transrectal ultrasound of the prostate).

TRANSRECTAL ULTRASOUND OF THE PROSTATE (TRUSP OR TRUS):

A method that uses the echoes of ultrasound waves to image the prostate by inserting an ultrasound probe into the rectum.

TRANSURETHRAL:

Through the urethra. See Transurethral Resection of the Prostate.

TRANSURETHRAL RESECTION OF THE PROSTATE (TURP):

A surgical procedure to remove prostate tissue obstructing the urethra.

T SCORE:

A designation used in evaluation of bone mineral density that relates the patient's bone density to that found in a population of healthy women of approximately 30 years of age. The T score is in contrast to the Z score, which relates the patient's bone density to a pooled population of an age similar to the patient. The T score is the desired test result. (No T score levels have been ascertained for men as of the end of 2002.)

TUMOR:

An excessive growth of cells caused by uncontrolled and disorderly cell replacement that can be either benign or malignant.

TUMOR VOLUME:

The amount of tumor measured in cubic centimeters.

ULTRASENSITIVE PSA ASSAY:

PSA assays that are able to measure very small amounts of PSA in the blood sample, reliable to the hundredth or even the thousandth of a nanogram per milliliter of blood. Tosoh and DPC Immulite Third Generation assays are examples of ultrasensitive PSA assays.

UPREGULATING (UPREGULATION):

Turning on or increasing a mechanism of action at the biochemical level in the body.

UROKINASE-TYPE PLASMINOGEN ACTIVATOR (uPA):

A substance believed to play a role in prostate cancer invasion and metastasis that is stimulated by IGF-1 and inhibited by GLA and EPA.

UROLOGIST:

A surgically trained physician who specializes in disorders of the genitourinary system.

VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF):

A substance known to stimulate blood vessel growth or angiogenesis and hence to stimulate PC growth.

VIADUR:

Brand name of an LHRH agonist that is implanted under the skin and releases medication over the course of one year.

VITAMIN E SUCCINATE:

Substance that inhibits the growth of prostate cancer cells of certain cell lines by suppressing androgen receptor expression and PSA expression.

WATCHFUL WAITING:

Objective ongoing observation and regular monitoring of a patient with prostate cancer without actual treatment or invasive therapies.

ZOLADEX:

Brand name of one of the LHRH-agonists.

Z SCORE:

 

A designation of bone mineral density that relates the patient's bone density to that of a pooled population of similar age. See T Score.

Suggested Reading

Those seeking additional information may order a copy of A Primer on Prostate Cancer, the Empowered Patient's Guide. The Primer reflects the synergistic efforts of Stephen B. Strum, a medical oncologist involved with PC since 1983, and Donna Pogliano, a partner of a PC warrior. The Primer is in full color with many graphic images, clinical vignettes, and a comprehensive appendix replete with material that is the essence of top-of-the-line health care as it relates to PC. The Primer is a working manual and companion tool to this protocol. The Primer is to be regarded as required reading for those serious at winning the war against PC. It is your basic field guide--but much more so. The Primer is available through Life Extension at (800) 544-4440 or on the Life Extension website at www.lefprostate.org. The Primer is also available through amazon.com, the Prostate Cancer Research Institute, the Educational Council for the Prostate Cancer Patient, and Barnes & Noble.

Additional Reading

Books About PC

  • Patrick Walsh, M.D., Janet Farrar Worthington.
    Dr. Patrick Walsh's Guide to Surviving Prostate Cancer
  • Sheldon Marks, M.D.
    Prostate & Cancer. A Family Guide to Diagnosis, Treatment & Survival

Medical Journals Focused on PC

  • Urology
  • Journal of Urology
  • Prostate
  • Prostate Cancer and Prostatic Diseases

PC Newsletters

  • Prostate Cancer Research Institute's PCRI Insights
  • Dr. Snuffy Myers's Prostate Forum
  • ECPCP's (Education Center for Prostate Cancer Patients) Prostate Exchange
  • PAACT's (Patient Advocates for Advanced Cancer Treatments) Cancer Communication

Internet Websites

Internet-Based Tools (Software)

Buy Disease Prevention and Treatment Fifth Edition
Order the Life Extension Annual Directory